Risk Factors for the Development of Ocular Complications in Herpes Zoster Ophthalmicus

Purpose: The purpose of this study is to report the incidence of herpes zoster (HZ) and herpes zoster ophthalmicus (HZO) in a large urban hospital system and to determine risk factors that are associated with the development of ocular complications in HZO. A secondary objective is to report the frequency of shingles vaccination and any episodes of HZ reactivation following shingles vaccination in this population. Methods: A retrospective cohort study was performed on patients seen at the University of Illinois Hospital system from 2010-2015 with HZ and HZO identified by diagnosis code. Medical chart review of HZO patients seen within 1 year of diagnosis of disease was performed. Patients with any ocular complication at 6 months and 1 year time points were compared to patients without ocular complications. Multivariable logistic regression analysis was performed to determine factors associated with the development of ocular complications in HZO. Results: During the study period, 1365 patients had HZ with an incidence of 332 per 100,000; the mean age of onset was 52 years, 60% of patients were female and 38% were black. HZO with confirmed ocular involvement was seen in 122 (8.9%) patients. Of 93 patients with HZO included in the analysis, the mean age was 57.8 years, and patients were predominantly female (55.9%) and Caucasian (39.8%). Ocular complications developed in 25 (27%) patients; the most common complication was corneal scarring (24.7%). Female gender (8.9, 95%CI 2.27, 35.1) and stromal keratitis (9.69, 95% CI 2.66, 35.4) were associated with a higher odds of development of ocular complications. Shingles vaccination rates were low (0.4%) in this population during the study period, but only 4 (0.5%) patients developed reactivation of HZ following vaccination. Conclusions: HZ and HZO represent major public health issues. In HZO, female gender and stromal keratitis are strongly associated with development of ocular complications. Understanding risk factors for HZ/HZO can help to target populations for vaccination to prevent disease and long-term antiviral and anti-inflammatory therapy in those with disease.